Thailand is widely recognised as a leader in the global struggle against malaria, announcing in 2005 a 50 percent drop in morbidity and mortality rates from 1998 figures, five years ahead of schedule.
The number of reported cases dropped from 192,000 in 1998 to 51,000 in 2004.
Even so, the World Health Organization (WHO) and Department of Public Health view malaria as an emerging disease and report a sharp rise in infections since 2004. Last year, there were more than 63,000 reported cases.
According to WHO, half of all malaria cases in Thailand are in its four southernmost provinces – Songkhla, Pattani, Yala and Narathiwat. The other half are among migrant workers and displaced people from Myanmar, Laos, and Cambodia along the border.
"Malaria is a controllable disease, but there is a tendency for people to say it can't be controlled," Charles Delacolette, coordinator of the Mekong Malaria Programme, told IRIN.
However, critical challenges stemmed from an influx of counterfeit and substandard anti-malarial drugs into the country. Another serious hurdle, he said, was treating artesunate-sensitive and possible artesunate-resistant malaria. There is also a risk of these strains spreading from southeast Asia around the world.
Artesunate is an extract of the artemisia annua herb, a powerful anti-malarial therapy. Public health experts view artesunate, as part of Artemisinin-based combination therapy, as the best available weapon to combat multi-drug-resistant Plasmodium falciparum malaria in southeast Asia.
After successfully reducing malaria mortality and morbidity rates, the Thai government decreased funding for anti-malaria programmes. To make up the shortfall, the Global Fund to Fight Aids, Tuberculosis, and Malaria provided US$25 million for five years for diagnostics, treatment and the provision of long-term impregnated mosquito nets for all endemic villages in Thailand.
Malaria in the south
A Muslim insurgency in the southern provinces of Songkhla, Pattani, Yala, and Narathiwat has claimed more than 3,000 lives since 2004. To provide effective diagnostics, treatment and prevention in the area, the malaria control programme within the Department of Public Health collaborates with local health authorities and humanitarian agencies.
Special malaria posts have been set up in villages, and local people are trained to conduct rapid diagnostic tests, give prompt treatment for positive cases, and provide long-lasting impregnated bed nets to villagers.
But according to Delacolette, the ongoing conflict makes it difficult to assess the impacts of the malaria control programme.
Border regions
A Malaria Task Force was established in 1995 to provide malaria control programmes along the Thai-Myanmar border. Several international NGOs provide malaria services to approximately 140,000 people in nine refugee camps. These include Kenan Institute Asia, American Refugee Committee International, Malteser International, International Rescue Committee (IRC), Aid Medical International, and Shoklo Malaria Research Unit (SMRU).
 Photo: Dr. Charles Delacolette/Mekong Malaria Programme  |
| A Thai family with its insecticide-impregnated bednet |
SMRU is a field station of the faculty of Tropical Medicine, Mahidol University, and part of the Mahidol-Oxford Research Unit (MORU). It operates four health clinics along the border. Last year, SMRU treated approximately 20,000 people with malaria, mostly migrant workers who crossed the border seeking medical care.
Verena Carrara, a malaria specialist with SMRU, told IRIN that infections were persistent and highest during the rainy season.
"Thailand has a wonderful malaria control programme," Carrara told IRIN, "but borders are more difficult to control, because people work in the forests where mosquitoes are born."
She added the greatest challenge SMRU faces was accessing people with malaria due to frequent border closures and floods.
Counterfeit and substandard anti-malarial drugs
An international team of scientists and public health workers, coordinated by Interpol, recently uncovered an enormous fake anti-malarial drug syndicate in southern China. Huge stockpiles of the drugs were seized, but as many as 240,000 packs of counterfeit artesunate have reportedly been sold across Asia, according to research led by Paul Newton of Oxford University's Centre for Tropical Medicine.
 Photo: Dr Charles Delacolette/Mekong Malaria Programme |
| Health workers map the villages with incidences of malaria of which they will follow-up, using push-pins of different colors to denote the number of cases |
Most of the drugs seized contained no artesunate, but experts say small doses often show up in fake drugs. The doses are too small to be effective, but they are strong enough to contribute to malaria parasites developing resistance.
WHO estimates that 200,000 of the one million annual malaria deaths worldwide would be prevented if all the drugs taken were genuine.
Artesunate is showing signs of sensitivity or possible resistance not just in southeast Thailand but Cambodia as well. Nick Day, director of MORU, said it was too early to speak of resistance but he told IRIN that work had to be done quickly to prevent a health crisis.
"Traditionally, malaria parasites in southeast Asia are the most drug-resistant in the world," said Day. "The best way to try to stop artesunate-resistant malaria from spreading is by containing and eradicating malaria in the region."
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This article was produced by IRIN News while it was part of the United Nations Office for the Coordination of Humanitarian Affairs. Please send queries on copyright or liability to the UN. For more information: https://shop.un.org/rights-permissions
